Healthcare Provider Details

I. General information

NPI: 1710240916
Provider Name (Legal Business Name): KARL JOHN HAGER JR. NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 46
EKALAKA MT
59324-0046
US

IV. Provider business mailing address

2 SPRINGSIDE CT
HATTIESBURG MS
39402-7053
US

V. Phone/Fax

Practice location:
  • Phone: 406-775-8730
  • Fax: 406-775-6479
Mailing address:
  • Phone: 601-270-9568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3013514
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNUR-APRN-LIC-174678
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR870265
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR870265
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-APRN-LIC-174678
License Number StateMT
# 6
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNUR-APRN-LIC-174678
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: